I have referred your website on FB and here on RU-vid to MANY of my friends and have gotten nothing but good feed back from them. Thank you so much for taking the confusion out of so many Medicare issues! Less confusion, less stress!
We *love* to hear this, David! Thank you for recommending our channel to your friends :) We greatly appreciate it! Our team is always here and happy to help answer your Medicare questions. We agree - less confusion, less stress!
Thank you for explaining this. I don't even know about this because we don't have this type of insurance in our country until I work as a customer service representative for healthcare insurance company. Been working for 3 years and this is the only time I understand how this works.
my father got a supplement and they told him he only had to pay his part B deductible, and then everything would be covered at 100% not 80% does this sound right? He has not used it yet, but our insurance provider told us that he after he covered his deductible that he would not pay anything for any visit after that for part outpatient visits.
What about Wyoming? I have Aetna. As far as I could find, there is no medigap plans offered! So, I have A & B, plus D. I'm 100% disabled through SSD. Will be 62 in February.
Wyoming does offer Medigap plans. However, carriers are not required to offer Medigap plans to those who are under age 65. Once you reach Medicare age, you will be given a second Medigap Open Enrollment to apply for a Medigap plan without underwriting. In the mean time, you could consider a Medicare Advantage plan, as these plans can help with your cost-sharing and have lower premiums. Check out our RU-vid video, Medicare for People Under 65 | What You Should Know
I was scheduled for outpatient surgery this month. After completing all my labs and imaging, I asked my surgeon's office to send me an itemized estimate of costs for just the surgery. Not only did they not provide me with an itemized list, they told me that my Plan G (Anthem) would NOT cover the 20 percent left over from Medicare Part B. I initially suspected I had inadvertently purchased (from Boomer Benefits) a high deductible Plan G, but a phone call to Anthem confirmed this was not the case, that my deductible was $233. Now, wouldn't it be Medicare's job to send the 20 percent bill to Anthem, and not the surgeon's office? And could the Plan G deny paying for services that Medicare has approved? Is my surgeon's office wrong, or am I missing something here? I should mention that I bought my Anthem plan in California, but my surgery was to be in Phoenix.
George, if Medicare pays, so will your Medigap plan! Since you are a Boomer Benefits client, you can give our team a call at 817-249-8600 and we can look into this for you!
I have a medigap and part D. I expect to move to another state this year. Will my deductibles for all three reset to zero when I move or will they continue to add together to hit the yearly amounts?
So when you visit a doctor there is no out of pocket cost at the time of the visit, is this correct ? In other words, you do not pay the doctor any money at the time of the visit? The doctor must bill you the difference between what medicare pays and what you owe the doctor correct?
Hi there - The customary process is for you to pay nothing up front, have your visit, the doctor then bills Medicare, Medicare pays their part, then sends the bill to your Medigap plan. Your plan pays its part, then sends the remaining bill (the Part B deductible) back to the doctor, who then bills you. Although it is not mandatory for them to bill Medicare first, most offices follow a customary process. It is best to avoid paying up front if you can, but if you have to pay up front, keep all proof of the payment and ensure your Medicare Summary of Notice reflects that.
If your first medical service of the year was $400, Medicare would subtract $233 (yearly deductible) and pay 80% of the remaining $167 or $133.60. The medical provider will send you a bill for $266.40 to cover the deductible and your 20% coinsurance of $33.40. Now that your deductible is paid for the year, you will be responsible for 20% of any future covered services. Your coinsurance can be reduced or eliminated with a Medigap policy.
What if your first visit of the year entails a preventative procedure that should be 100% covered such as a bone density test. Will the Medicare deductible still apply?
Wait I have a question, I understood everything except the total owed of $146.40. Where did that amount come from? From my understanding, the deductible works like a bank. You have $233 in your bank account. It pays off medical visits. The leftover stays there until the next visit where now the insurance pays a certain amount whereas you spend a short amount because the leftovers aren't enough to pay off for the second visit. So where did that total owed of $146.40 come from?
Hi there, we give this example in the video - If Medicare allows the doctor to charge $100 for your visit, then Medicare will apply that deductible to the bill, and your doctor will bill you for the $100. But now you still owe the rest of the deductible - in 2022, since the deductible is $233, you still have $133 to go before Medicare starts paying 80% of your outpatient care. Let’s say you then go in for a specialist visit two months later. The specialist bills Medicare, and Medicare will apply the remaining deductible charge to that second bill, short-paying it by $133 before paying 80% of the rest of the charges. The specialist will send you a bill for that $133 and 20% of any remaining charges. Once you pay that second bill, you have now satisfied that entire Part B deductible for the year.
Hi Sharon - There are 3 ways you can pay for Medicare if you are not taking SS benefits! You can use Medicare Easy Pay, Mymedicare.gov, or use your banks Bill Payment Service. Learn more about this here: boomerbenefits.com/how-to-pay-medicare-premiums-online/
so a medical supply company cannot charge me for the deductible on supplies until process through Medicare first? Asking cause medical supply company says I need to pay them the deductible to process my order to get sent out?? I didn't understand how and if other charges on deductible made already been process from other medical service's I have received already? Thanks
We do not recommend paying the deductible up front to avoid billing issues! If you are a BB client, give us a call and we can help. If not, save your invoice once you pay, so that you have proof of payment if you do run into issues.
Excellent explanation. But what if you receive two instances of service close to simultaneously? Would it be possible for two different providers to hit you up simultaneously for your $233 deductible? And if that's possible, how can a Medicare Part B insuree get his/her overpaid deductible refunded? Thanks.
This is why you would not want to pay anything upfront at your visit, that way you will not be double charged for the Part B deductible. Medicare keeps track of everything, so Medicare will know if you have already paid the Part B deductible. Now, sometimes people pay the deductible up front and do get double billed - this is what our Client Service Team can help with and get you that reimbursement.
Hi Charles - The process still remains the same! You only pay the copay after you have met the Part B deductible with Plan N. After you have met the deductible, you will likely pay a copay for your doctor visits for the rest of the year.
I pay full currently as he doesn't take any kind of insurance. I was just wondering if I get penalized if I don't go for an initial exam using medicare
Great question, Tom! Check out our article here, where we compare Original Medicare to Medicare Advantage plans: boomerbenefits.com/original-medicare-vs-medicare-advantage/
Hi there! The correct process is for you to pay nothing up front, have your visit, the doctor then bills Medicare, Medicare pays their part then sends the bill to your Plan G. Plan G pays their part, then sends the remaining bill (the Part B deductible) back to the doctor. Then and only then should the doctor bill/charge you for the deductible.
Hi Sandra - Yes, in order for your doctor to bill Medicare they must accept Medicare as insurance. If they don't accept Medicare and you don't have any other form of insurance, then you will pay the full cost of your visit.
Most important on Part A- B-- Do not sign up before your 65. Sign up in the month you turn 65 yrs of age. they say you can sign up 2 months before BUT do not tell you they start charging you $170.11 for the 2 months before your 65. You can even sign up on the last day of month for full coverage of that month.
Hi Bob - If you sign up for Medicare within the first 3 months of your Initial Enrollment Period, your Medicare will begin on the first of your 65th birthday month. If you apply for Medicare the month you turn 65, Medicare begins 1 month after you signed up. If you wait until the last month of your IEP to apply for Medicare, Medicare will begin 3 months after you signed up. So, keep this in mind as you will have a delay in coverage if you push off enrolling in to Medicare.
I signed up 3 months to the day before my birthday month, and was not billed till the 20th of month before my start date. So, my experience does not confirm your hypothesis.
